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Understanding the Stages of Addiction

Researchers say about 10 percent of American adults will have a drug use disorder at some point in their lifespan. If this is you — or someone you love — it's helpful to understand the stages of addiction. The more you know, the better you can help.

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You can stop the cycle of drug abuse and live a better life.

These are the accepted stages of addiction:

  • Initial use
  • Abuse
  • Tolerance
  • Dependence
  • Addiction
  • Relapse 

Let’s walk through these stages one by one. 

What Does Initial Use Look Like?

In 2017, experts said about 5.5 percent of the global population used drugs in the year prior. This news was alarming, as it represented a big increase from previous estimates. If these trends continue, more people will start using drugs every year. 

Most drugs work on chemical systems deep inside the brain. The very first hit produces a surge of happy feelings and contentment. Some people will spend the rest of their lives chasing the memory of that first high. 

No single factor can predict whether the first hit triggers an addictive process. But known risk factors for addiction include the following:

  • Aggressive behavior in childhood
  • Lack of parental supervision 
  • Poor social skills 
  • Ready access to drugs
  • Living in a poor community 

People with these traits who use drugs, even once, could change their lives. 

What Does Substance Abuse Look Like?

Medical experts define drug abuse as using chemicals without a prescription or using drugs in a manner a doctor doesn’t condone. Under this definition, anyone who buys a prescription painkiller from a friend is abusing it. 

Addiction medicine clinicians use a slightly different definition. To them, drug abuse involves using substances to do the following:

  • Counteract a negative mood 
  • Augment a happy mood 
  • Reduce feelings of boredom 
  • Tolerate a difficult occasion, such as a job interview

People who abuse drugs are looking for ways to hijack the brain’s normal processes. They hope to smooth out difficult feelings and make themselves feel happy, content, or sedated. They may not understand that these tweaks can have serious consequences. 

What Does Drug Tolerance Look Like?

A hit of drugs may seem to wear off relatively quickly, but deep inside the brain, the drug can cause persistent changes. In time, those adjustments can lead to drug tolerance. 

Someone with drug tolerance takes bigger doses. One pill doesn’t have the impact it once did, and the person must use more to feel the same sensation.

Anyone who uses drugs for a long period can develop tolerance. For example, people using prescription painkillers for cancer-related discomfort often need bigger doses over time to stay calm and comforted. 

Tolerance alone doesn’t indicate addiction, but it can entice people to make poor decisions. Someone tolerant to painkillers, for example, might shift to less expensive (but more dangerous) solutions like heroin.

What Does Drug Dependence Look Like?

As the person continues to take drugs, brain cells optimize for substance abuse. In time, they cannot function properly unless chemicals are present. 

Physical dependence like this can set in with ongoing use of many different types of drugs, even if the person takes those substances as prescribed by a doctor

Withdrawal is the hallmark of drug dependence. When the person tries to quit using drugs, difficult physical sensations set in, and deep cravings for drugs accompany them. 

Painkillers cause a classic form of withdrawal. Within a few hours of the last dose, people develop flu-like symptoms, including these:

  • Vomiting
  • Sweating
  • Shaking 
  • Chills 
  • Headache
  • Muscle cramping 

While physical symptoms may resolve in a few days, psychological withdrawal symptoms can last for months. People feel depressed, weak, and desperate for the drugs they once took. 

Relapsing to drug use is likely when withdrawal symptoms are present. People want to make the discomfort go away, so they use drugs again.

What Does Drug Addiction Look Like?

Tolerance and dependence are common parts of drug addiction. But people who are addicted to drugs also have psychological symptoms that compel them to keep using. 

Someone with a drug addiction will demonstrate the following:

  • An inability to stop: The person wants to either cut back or stop using drugs, but it seems impossible.
  • A focus on drug use: The person spends a lot of time getting the drug, using it, or recovering from a drug use binge. The person will give up activities that don’t involve drugs, including work and school. 
  • Recklessness: The person will keep using, even if it harms others or takes place in dangerous situations. 

When psychological and physical symptoms combine, the person may be completely unable to stop use without help. Some people believe that they simply can’t stop using, even if they want to. 

What Does Relapse Look Like?

Quitting drug use for an hour or two may be easy. But for someone with an addiction, staying away from drugs forever can seem really difficult and even impossible. The word relapse describes the process of quitting drugs and returning to them. 

Most people with addictions need at least two attempts at sobriety before they make it stick. Some need five attempts or more. 

A relapse isn’t a failure. People can study what made them return to drugs and make plans to protect them on the next attempt

Addiction Treatment Works

Almost half of all American adults say they have a family member or close friend who is addicted now or in recovery. 

Most of us have seen what addiction looks like firsthand. And many of us know that while addiction is a chronic condition, it can be managed. Recovery is possible.

Treatment programs work best when they last three months or longer. People need time to let their brains and bodies heal. 

And they need support to develop new habits and social connections. When psychological triggers appear, as they will, these protective factors can prevent another relapse. 

It’s difficult to measure just how “effective” addiction treatment is, as this is a chronic condition marked by treatment noncompliance. Back in 2004, experts said people with addictions stop following their plans just like people with relapsing health conditions do. Just as people with diabetes may experiment with quitting meds, people with addictions may experiment with skipping therapy appointments. 

Studies that measure treatment effectiveness may look at relapse rates only. That measurement doesn’t fully encompass what recovery looks like. 

If you or someone you love has an addiction, know that treatment can help you stop using. Your recovery will take time, and you may need to work for the rest of your life to maintain it, but you can do it. You can stop the cycle of drug abuse and live a better life.

Updated April 24, 2023
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